Incident to Services for Allergy Shots?

Here is a question and answer that will help you while doing your daily otolaryngology coding job.

Otolaryngology coding scenario: I would like to get verification on billing for allergy testing (95004), allergen prep (95165), and allergy injections (95115 or 95117). In actuality, our nurse is the person doing all of these procedures and then the physician takes a look at the information at a separate time. Does a physician need to be present in the office at the time any of these procedures are being carried out?

Allergy shots are a therapeutic service and therefore fall under incident to services. Therefore, this falls under the incident to rules. This means that a doctor or a non physician practitioner must be in the office suite when the injections are administered. As per Medicare rules, you should bill the injections codes (95115 and 95117) under whatever provider is present in the office – the physician or the non physician provider.

Preparation of the allergen serum (95165) and allergy testing are diagnostic services; they don't fall under incident to rules, instead fall under the Medicare supervisory rules for diagnostic services, which happen to look exactly like incident to services. As the supervisory level for the diagnostic services for most of the allergy testing looks exactly like incident to level, many people get the two rules confused. As such, for most of the codes, a physician or non physician practitioner must be in the office. Some of the higher risk allergy testing codes, such as 95065, (Direct nasal mucous membrane test) have a supervision level of ‘personal supervision', which means that the doctor must be in the exam room with the patient when the testing takes place.

CPT 95165, (Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens [specify number of doses]) doesn't require physician per the supervision guidelines from Medicare.

As far as other payers are concerned, it is dependable on their policies for billing for the supervision of diagnostic procedures and incident to services for the allergy shots. You should get all your non Medicare policies in writing.

For further details on the levels of required supervision as well as other medical coding updates pertaining to your specialty, sign up for a good one-stop medical coding guide like Supercoder. In fact, such a site will assist you in all your otolaryngology coding scenarios.